Multiple Sclerosis on Speech and Swallowing
Multiple sclerosis, or more commonly referred to as (MS), is a disease that effects the neurons in our brain and spinal cord. In MS, our own immune systems mistakenly attack the neurons within our body that send electrical signals all over the place! In MS our immune system mistakenly attacks things in our body that are not foreign invaders. In fact, it attacks things that we need! Our body’s immune system is attacking the neurons within our body. The message being sent by the electrical signal does not come in as fast. This causes the electrical signal in our body to be interrupted or distorted.
So, what are the speech related issues found in MS? Researchers have found that 41-51% of individuals with MS experience speech problems. Individuals with MS report having difficulty being understood, making the sounds they want to make, speaking quickly and being loud. If the neurons providing power to all the structures and responsible for these movements in our body are not working properly, what happens? Well, there may be stiffness, weakness, slowness and incoordination of all the structures needed for speech production.
The first characteristic highlighted is speech where the normal pattern or melody of speech is disrupted. With this type of speech, the listener will notice abnormally long pauses between words and syllables. The second characteristic highlighted is slurred speech. This happens because there is an incoordination of the muscles in the lips, tongue, check and mouth. 77% of people with MS accompanied by speech problems have issues with controlling loudness. While some people are not able to speak loud enough, others are too loud, monotone or variable in their loudness.
In addition to speech problems, MS also results in voice problems for some individuals. In fact, 72% of individuals with MS accompanied by voice problems have a “harsh” quality of voice. This makes their voice sound very strained to the listener. Another speech problem experienced by individuals with MS is problems making the sounds they want to make, when they want to make them. Moreover, cognitive problems related to MS may cause individuals to have word finding difficulties. Another problem individual’s may have is emphasizing what they want to in a sentence. Individuals with MS may have a hard time controlling the stress and pitch in their speech. Their voice may sound monotone or slow. This may have a large impact on the effectiveness their communication. In fact, 37% of individuals with MS accompanied by speech problems have a hard time controlling their pitch. They may sound monotone, have a very high pitch, a very low pitch or sudden changes in pitch. Moreover, 35% of individuals with MS accompanied by speech problems have a hard time having enough air in their lungs to support speech. This may result in individuals producing shorter sentences before having to take another breath. More nasality than usual in speech occurs in 24% of individuals with MS accompanied by speech problems. It is important to note that MS can attack any neuron in the body, and as a result individuals with the disease experience a variety of symptoms! If someone with MS has speech problems, they may also have swallowing problems resulting in aspiration. This is extremely dangerous and happens sometimes in severe cases of MS.
Treatment for speech related problems may be helped with medication (to help relax the muscles) and speech therapy. In speech therapy, the speech therapist may incorporate exercises that may strengthen or relax vocal cords, or control how the individual moves their tongue, lips and jaw. Other strategies may involve working with the different symptoms that MS causes. For example, the therapist might work on the individual producing shorter words, phrases and sentences. As was mentioned previously, MS can affect the neurons that provide electricity to the muscles that are responsible for breathing. If the message is distorted (as it can be in MS), then the person may be unable to have enough respiratory power to say what they want to say. This may result in the awkward pauses between words and sentences. Sometimes, it helps the individuals with MS if they practice controlling their breath or producing shorter sentences so that they have enough air to complete the sentence in a way that is understandable to the listener. Problems with loudness can be aided by using a technique that focuses on “getting loud” which, has really been proven to help individuals become more understandable to the listener. A speech therapist may also work on helping the individual with MS control their speaking rate. This can be done using finger tapping, or really cool advanced technology (such as a system that plays the person’s voice back to them after they have said something). Combining these techniques typically helps individuals say what they want to say, when they want to say it and in a way that is understandable to the listener. In the most severe cases, individuals may use devices that speak for them!
– Alexandra F.